Standardizing Antimicrobial Prophylaxis in Pediatric Patients Requiring Extracorporeal Membrane Oxygenation

Area of Science:

• Pediatric critical care medicine
• Infectious disease management
• Extracorporeal membrane oxygenation (ECMO) support

Background:

• Antimicrobial prophylaxis guidelines for pediatric extracorporeal membrane oxygenation (ECMO) patients are not standardized internationally or nationally.
• Lack of clear guidelines leads to inconsistent antimicrobial use in this vulnerable population.

Purpose of the Study:

• To analyze the impact of implementing a narrow-spectra ECMO antimicrobial prophylaxis protocol.
• To standardize antimicrobial prescribing based on ECMO type and configuration.
• To compare antimicrobial use appropriateness and nosocomial infection rates before and after protocol implementation.

Main Methods:

• Retrospective, single-center study of pediatric patients (<18 years) requiring ECMO from May 2018 to December 2021.
• Inclusion of medical and cardiac surgical patients on various ECMO configurations (central/peripheral, veno-venous/veno-arterial).
• Comparison of antimicrobial prescribing appropriateness and nosocomial infection rates in pre-protocol versus post-protocol periods.

Main Results:

• Patients in the post-protocol period were 4 times more likely to receive appropriate antimicrobial prescribing (OR 4.4, P=0.036).
• Appropriate prescribing included both prophylactic and therapeutic antimicrobial use.
• No significant difference in the incidence of nosocomial infections (invasive or overall) was observed between the pre- and post-protocol groups.

Conclusions:

• A standardized, narrow-spectra ECMO antimicrobial prophylaxis protocol significantly increased appropriate antimicrobial prescribing.
• The protocol implementation successfully standardized antimicrobial use without increasing nosocomial infection rates.
• This approach offers a safe and effective strategy for antimicrobial stewardship in pediatric ECMO patients.